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Fear of Prescribing Opioids Creates ‘Pain Refugees’

Fear of Prescribing Opioids Creates ‘Pain Refugees’

Some of Montana's chronic pain patients are traveling far away from home to receive adequate opioid treatment regimens.

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"Had I stayed in Montana, I would have killed myself," Gary Snook, a self-proclaimed “pain refugee” who has to fly to Los Angeles every 90 days to receive adequate pain treatment, told NPR in a recent report about the cruelty of restrictive opioid prescribing.

Yes, opioid pain relievers are responsible, at least in part, for driving up mortality rates across the country. And yes, for much of the ‘90s and early 2000s there were—and continue to be—some bad actors that prescribed powerful painkillers indefinitely to patients whose condition did not require such a regimen. In some cases, these practices caused addiction, overdose, and death.

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But when the pendulum rapidly swings from liberal to restrictive prescribing practices (per the CDC guidelines), are lives being saved or is more suffering created? For a group of pain patients in Montana who can’t find a doctor willing to prescribe opioids, it appears to be the latter.

"I believe pain control is a fundamental human right, or at least an attempt at pain control," said Snook. "To deny someone with a horrible disease like me access to pain medications is the worst form of cruelty."

Snook acknowledged to NPR that it may look like he is coming off as “desperate” for pills, like someone who is addicted to painkillers. But finding bonafide addiction in chronic pain patients is uncommon, according to a 2010 Cochrane review of the literature. The authors of that review conclude, “Many minor adverse events (like nausea and headache) occurred [as a result of long-term opioid use], but serious adverse events, including iatrogenic opioid addiction, were rare.”

"My pain, it's all from my waist down," Snook told NPR. "It's like being boiled in oil 24 hours a day." He is looking for treatment, not a fix.

But adequate care is scarce in Montana. Marc Mentel, chair of the Montana Medical Association committee on prescription drug abuse, confirmed Snook’s plight. He told NPR that Montana doctors are wary of opioid prescribing, fearing they may addict their patients.

As a result, Snook is forced to make the trip to suburban Los Angeles every 90 days to visit Dr. Forest Tennant, who runs a small strip-mall practice. Dr. Tennant felt he had to state the obvious, that opioids help people and because of that they should be used. But there’s a caveat, "You don't use them until everything else has failed," he says.

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Such is the case for Snook and his two comrades. Snook himself has tried every treatment under the sun: surgeries, epidural steroid injections, acupuncture, anti-inflammatories, physical therapy, pool exercises, and the list goes on.

"I've tried anything that anyone has ever suggested me to try,” he said. “Unfortunately what I do right now is the only thing that works."

And because of that, says Dr. Tennant, opioids shouldn’t be stigmatized.

Zachary Siegel is a freelance journalist specializing in science, health and drug policy. His reporting has also appeared in Slate, The Daily Beast, Salon, Huffington Post, among others. He writes often about addiction, sometimes drawing from his own experience. You can find out more about Zachary on Linkedin or follow him on Twitter.

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